Patients Deserve Access to Copay Assistance

For individuals living with rare and chronic conditions, like cancer, hemophilia, arthritis and many others, access to effective treatment is often made possible through copay assistance. Many of these patients and their families rely on financial support from nonprofit organizations and prescription drug manufacturers to help them afford the medicine they need.

As Michigan families fight their way through the COVID-19 pandemic, the last thing patients need are unexpected health costs. Unfortunately, new insurance company policies threaten to deliver just that.

Insurance companies and health plans have begun instituting “copay accumulator adjustment programs.” These programs mean that insurance companies refuse to count copay assistance dollars towards a patient’s deductible and out-of-pocket maximum for the year.

In other words, if a patient with a serious health challenge uses copay assistance to pay for his or her $5,000 monthly treatment, the health insurance plan can exclude that copay assistance when calculating the patient’s out-of-pocket maximum.

This means that the patient will have to pay the $5,000 a second time out of their own pocket. The out-of-pocket costs for the treatment are being paid twice and the patient takes the hit.

All 9 of the 2021 individual marketplace plans in Michigan have instituted this discriminatory practice.

There’s good news, though!

The Michigan state Senate is currently considering House Bill 4353 to guarantee insurance companies count all copayments made by or on behalf of Michigan patients towards their out-of-pocket maximums.

HB 4353 would ensure that all copays count, and for many patients, it’ll mean they’re able to get the medicine they need. HB 4353 is a health care reform that puts patients first. No wonder the state House already approved the legislation with an overwhelming, bipartisan vote.

Contact your state Senator today and ask him or her to ensure all copays count. Ask your Senator to put patients first. Ask your Senator to support House Bill 4353.